Taking away the keys? Case Western Reserve University law professors propose new rules for drivers with dementia
New law review article offers legislative guidance to balance patient autonomy with public safety
When a California woman with dementia swerved into oncoming traffic and killed her passenger, the victim’s family sued the treating physician—arguing he should have intervened to prevent her from driving.
A jury ultimately found the doctor was not liable, but the case exposed a troubling policy gap: What responsibilities do physicians have when they know their patients show signs of cognitive decline but continue to drive?
Two Case Western Reserve University School of Law professors say current laws leave both doctors and families without clear guidance—and put public safety at risk.
In a new article published in the UC Irvine Law Review, Case Western Reserve School of Law professors Sharona Hoffman, the Edgar A. Hahn Professor of Law and co-director of the Law-Medicine Center, and Cassandra Burke Robertson, the John Deaver Drinko - BakerHostetler Professor of Law, analyzed the growing dilemma posed by older adults driving with cognitive impairment and proposed guidelines offering clarity for clinicians.
The goal, they argue, is to better protect the public.
“Hospitals and clinics see firsthand how cognitive decline affects judgment, reaction time and decision-making,” Hoffman said. “But clinicians operate in an environment where legal expectations are unclear. Physicians need to consider practical guidance and to protect patient rights—all while trying to help prevent avoidable tragedies.”
Hoffman and Robertson noted that current approaches—such as vision testing before license renewal or relying solely on family members—are insufficient.
Instead, they propose state legislation requiring physicians who diagnose cognitive decline to refer patients for standardized driving assessments. Under the proposed model, physicians would notify state departments of motor vehicles only when patients refuse testing or are deemed unsafe to drive. The authors also noted that police officers should be trained to identify potential cognitive decline in elderly drivers and refer at-risk individuals for driving assessments.
A growing concern
More than 32 million drivers nationally are 70 or older, according to the Insurance Institute for Highway Safety, and roughly 10% of adults over 65 are living with dementia, per the Alzheimer’s Association. Hoffman and Robertson expect that the tension between personal autonomy and roadway safety will only intensify as the baby boomer population ages.
For many older adults, however, driving represents far more than transportation. It is essential to independence, social connection and quality of life. According to the professors’ research, losing the ability to drive can lead to social isolation, dependence on others and significant declines in mental and physical wellbeing.
Robertson said this makes the decision about when someone should stop driving particularly fraught.
“Our goal is to strike a balance between autonomy and safety,” she said. “We want to empower physicians with a clear process—not to take away keys themselves, but to ensure that trained evaluators make informed decisions about driving ability. This creates a system that is fair to patients and far more protective of the public.”
